Brief Answer:
Metabolic Syndrome

Detailed Answer:
Good evening XXXX

Thank you for writing on health care magic

I have gone through your history and the reports. You are having a condition called MEtabolic Syndrome--> High Body mass index, hyperuricemia, high triglyceride levels and borderline diabetes( not sure about the blood pressure part).

Well, it is good that you have cut down on the weight as obesity is a major predictor which progresses the disease causing early diabetes.

Recurrent attacks of Gout, with such high uric acid it something which cant be cured completely. Normally we dont start treatment for hyperuricemia unless the attacks are more than 3/year or patient has stones in the kidneys. But if you are getting recurrent attacks, you will have to be on long term medications. Consider it like Diabetes, where one has to take long treatment to control the further attacks and other harmful effects of high uric acid.

If you could throw some more light on your treatment details, it would be helpful. The maximum doses tried and the medications tried. Cause with such lab derangement's we need to form a good treatment, diet and exercise plan for you to prevent further disease progression.

But yes, some medications need to go on to sustain healthy life style.

Do let me know these details. would guide you further from here

Regards
Dr Naval

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Brief Answer:
Gout Management

Detailed Answer:
GOod afternoon XXXX

I have gone through your reply.

Since you are getting recurrent attacks of gout and it has started ascending...Big toe to ankle, it is neccessary you control your uric acid levels well. Ideally it should be less than 6.5 to prevent further attacks and the deposition of crystals in the joints( TOphi formation).

Kindly follow the advise as mentioned:

1. You can continue with your diet management, you are doing fine with it.

2. Daily exercises - 30-40 minutes in the morning. Brisk walk mainly

3. Further weight reduction

4. Drugs: You were on a very low dose of Zyloric. We normally start at 100 mg and go upto 600-800 mg depending on the uric acid levels. Cause either we treat it properly or we dont treat it at all. Midway is never a solution, as you are taking medicine and still the uric acid levels are high. So I would suggest you increase it to 300 mg daily or we can switch to Febuxostat as well. Both are equally good. Zycolchin/Nucoxia you can use it during the attacks only, but if you are on continous zyloric dont stop it during the attacks either as we lose time in restarting it again.

Incase you are not on any medicine..I would suggest go with zycolchin 0.5 twice daily for 15 days and then add zyloric and slowly titrate it up.

It is a bit disheartning considering it cant be cured fully, but if it remains under check with medicine that itself would be an acheivement.

Hope the formation was useful

Do let me know for more queries. Would be happy to help out

Regards
Dr Naval

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Brief Answer:
Gout management

Detailed Answer:
Good evening

For the medications:

1. Take Zycolchin 2 tablets daily for a month 0.5 mg

2. I would recommend Zyloric over Febutas as it is still a better drug. With Zyloric you need to monitor your complete blood count and liver function tests along with serum creatinine and uric acid every 3 months. It does not affect the kidneys as such but Liver function and complete blood counts are needed.

Timing Of Zyloric: after 15 days of Zycolchin to prevent gout flares. Start at 100 mg once daily..Increase to 200 mg after a week and then to 300 mg after another week. Further dose tit-ration will depend on your uric acid levels and the gout attacks.

Just watch for any rashes or vomiting. Since you have already taken it before , it should be a safe bet.

Hope it suffices. Be in touch with a rheumatologist around your place than a physician

REgards
Dr Naval

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